Dysphagia for Liquids Progressing to Dysphagia for Solids

CLINICAL DIAGNOSTIC MANUAL

Dysphagia for liquids that progresses to dysphagia for solids is a progressive condition suggesting an impairment in oesophageal motility or neuromuscular dysfunction.

Unlike dysphagia for solids that progresses to liquids, this form of dysphagia indicates a gradual weakening of the muscles responsible for swallowing, initially affecting liquid intake and subsequently solids. Early and accurate evaluation of the underlying cause is crucial for appropriate management and improving the patient’s quality of life.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Pseudobulbar palsy	Dysphagia, dysarthria, emotional lability, facial weakness	History of neurological disease, physical examination	Brain MRI, neurological evaluation
Scleroderma	Dysphagia, thickened and hardened skin, gastroesophageal reflux, telangiectasias	History of connective tissue disease, physical examination	Specific antibodies (ANA, anti-Scl-70), oesophagram
Bulbar palsy	Dysphagia, dysarthria, tongue atrophy and fasciculations, facial weakness	History of neurological disease, physical examination	Brain MRI, electromyography (EMG), neurological evaluation
Myasthenia gravis	Dysphagia, fluctuating muscle weakness, ptosis, dysarthria, fatigue	History of fluctuating muscle weakness, physical examination	Anti-AChR antibody test, electromyography, edrophonium test
Motor neuron disease	Dysphagia, progressive muscle weakness, muscle atrophy, fasciculations	History of progressive weakness, physical examination	EMG, brain and spinal MRI, neurological evaluation
Diffuse oesophageal spasm	Intermittent chest pain, dysphagia for liquids and solids, sensation of a lump in the throat	History of episodes of chest pain and dysphagia, physical examination	Oesophagram, oesophageal manometry, endoscopy
Achalasia	Dysphagia for liquids and solids, regurgitation, weight loss, chest pain	History of progressive dysphagia, physical examination	Oesophageal manometry, oesophagram, endoscopy